Objective To investigate the relation between the sites of colorectal cancer and liver metastatic distribution.
Methods The enhanced multiple-slice spiral CT images and clinical data of 105 cases diagnosed colorectal
cancer with liver metastases admitted from January 2010 to April 2012 were analyzed retrospectively. Primary site of the tumor， numbers of the metastases on CT images， and the anatomical position of the inferior mesenteric vein （IMV） terminates were recorded.
Results ①The ratio of metastases in the right and left hemiliver was 2∶1 for 38 right-sided primary tumors as compared with 1.2∶1 for 67 left-sided primary tumors. The pattern of lobar distribution was significantly different in the two groups （χ2=8.709， P=0.003）. ②In the left-sided colon cancer group， the ratio of metastases in the right and left hemiliver was 65∶98 for 28 patients with IMV terminating in splenic vein （SpV）， 116∶52 for 36 patients with IMV terminating in superior mesenteric vein （SMV）， and 13∶15 for 3 patients with IMV terminating in the junction of SMV and SpV. The pattern of lobar distribution was significantly different among the three groups （χ2=28.575， P=0.000）. Further comparison between the former two groups， the difference was statistically significant （χ2=27.951， P=0.000）. ③In 25 patients with IMV terminating in SpV， the metastases of 19 cases were mainly distributed in the left lobe of liver （P=0.001）；In 34 patients with IMV terminating in SMV， the metastases of 25 cases located mainly in the right hepatic lobe （P=0.000）.
Conclusions Right-sided colon cancers selectively involve the right lobe of liver， while left-sided tumors selectively involve the right lobe of liver when its IMV terminates in SMV and involve the left lobe when its IMV terminates in SpV， respectively. The discovery may help shorting the diagnostic workup in patients presenting with liver metastases from an unknown primary site， and may improve the detection rate of metastases in initial diagnosis and follow-up.
Citation：
BAI Jiao,ZHANG Ge,ZHOU Yin,YANG Ling,ZHAO Shuang,LIU Rongbo. Distribution Characteristics of Colorectal Cancer with Liver Metastases on CT Images. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(11): 1238-1242. doi:
Copy
Copyright © the editorial department of CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY of West China Medical Publisher. All rights reserved
| 1. |
Martinet O， Reis ED， Gillet M. Gene therapy and liver metastases[J]. Schweiz Med Wochenschr， 1999， 129(34)：1187-1195.
|
| 2. |
夏振龙. 大肠癌肝转移的发生率及临床特点[J]. 中国实用外科杂志， 1999， 19(10)：3.
|
| 3. |
Horton KM， Fishman EK. Volume-rendered 3D CT of the mesenteric vasculature：normal anatomy， anatomic variants， and pathologic conditions[J]. Radiographics， 2002， 22(1)：161-172.
|
| 4. |
季加孚. 结直肠癌肝转移的分子生物学基础[J]. 实用肿瘤杂志， 2003， 18(2)：84-87.
|
| 5. |
Faivre J， Manfredi S， Bouvier AM. Epidemiology of colorectal cancer liver metastases[J]. Bull Acad Natl Med， 2003， 187(5)：815-823.
|
| 6. |
Adam R， Huguet E， Azoulay D， et al. Hepatic resection after down-staging of unresectable hepatic colorectal metastases[J]. Surg Oncol Clin N Am， 2003， 12(1)：211-220.
|
| 7. |
Arru M， Aldrighetti L， Castoldi R， et al. Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer[J]. World J Surg， 2008， 32(1)：93-103.
|
| 8. |
Copher GH， Dick BM. “Stream line” phenomena in the portal vein and the selective distribution of portal blood in the liver[J]. Arch Surg， 1928， 17(3)：408-419.
|
| 9. |
Moore GE， Bridenbaugh RB. Roentgen demonstration of thevenous circulation in the liver; portal venography[J]. Radiology，.
|
| 10. |
Ito K， Shimizu A， Tsukuda T， et al. Evaluation of intraportal venous flow distribution by unenhanced MR angiography using three-dimensional fast spin-echo with a selective tagging pulse. efficacy of subtraction of tag-on and tag-off images acquired during a single breath-hold[J]. J Magn Reson Imaging， 2009， 29(5)：1224-1229.
|
| 11. |
Shirai Y， Wakai T， Ohtani T， et al. Colorectal carcinomametastases to the liver. Does primary tumor location affect its lobar distribution?[J]. Cancer， 1996， 77(11)：2213-2216.
|
| 12. |
Desai AG， Park CH， Schilling JF. “Streaming” in portal vein. Its effect on the spread of metastases to the liver[J]. Clin Nucl Med， 1985， 10(8)：556-559.
|
| 13. |
Konopke R， Distler M， Ludwig S， et al. Location of livermetastases reflects the site of the primary colorectal carcinoma[J]. Scand J Gastroenterol， 2008， 43(2)：192-195.
|
| 14. |
任黎， 蔡成机， 詹绍康. 结直肠癌发生部位与肝转移分布的关系[J]. 外科理论与实践， 2006， 11(1)：46-47.
|
| 15. |
吴阶平， 钟世镇， 裘法祖， 等. 腹部外科临床解剖学[M]. 济南：山东科学技术出版社， 2001：264.
|
| 16. |
钟唐力， 张小明， 赵建农， 等. 肠系膜下静脉. 三维动态增强磁共振血管成像研究[J]. 中国医学影像技术， 2007， 23(4)：570-573.
|
| 17. |
刘鹏， 鞠学红， 李春燕， 等. 16层螺旋CT检测肠系膜下静脉回流部位的临床意义[J]. 潍坊医学院学报， 2007， 29(2)：145-146， 197.
|
| 18. |
李萍， 宋彬， 邬颖华， 等. 消化道腺癌肝转移病灶的多排螺旋CT表现[J]. 中国普外基础与临床杂志， 2005， 12(5)：518-520.
|
| 19. |
汤敏， 孙俊波， 胡承雷. 肝转移瘤的CT诊断[J]. 西部医学， 2011， 23(1)：146-147.
|
| 20. |
， 57(5)：685-690.
|
- 1. Martinet O， Reis ED， Gillet M. Gene therapy and liver metastases[J]. Schweiz Med Wochenschr， 1999， 129(34)：1187-1195.
- 2. 夏振龙. 大肠癌肝转移的发生率及临床特点[J]. 中国实用外科杂志， 1999， 19(10)：3.
- 3. Horton KM， Fishman EK. Volume-rendered 3D CT of the mesenteric vasculature：normal anatomy， anatomic variants， and pathologic conditions[J]. Radiographics， 2002， 22(1)：161-172.
- 4. 季加孚. 结直肠癌肝转移的分子生物学基础[J]. 实用肿瘤杂志， 2003， 18(2)：84-87.
- 5. Faivre J， Manfredi S， Bouvier AM. Epidemiology of colorectal cancer liver metastases[J]. Bull Acad Natl Med， 2003， 187(5)：815-823.
- 6. Adam R， Huguet E， Azoulay D， et al. Hepatic resection after down-staging of unresectable hepatic colorectal metastases[J]. Surg Oncol Clin N Am， 2003， 12(1)：211-220.
- 7. Arru M， Aldrighetti L， Castoldi R， et al. Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer[J]. World J Surg， 2008， 32(1)：93-103.
- 8. Copher GH， Dick BM. “Stream line” phenomena in the portal vein and the selective distribution of portal blood in the liver[J]. Arch Surg， 1928， 17(3)：408-419.
- 9. Moore GE， Bridenbaugh RB. Roentgen demonstration of thevenous circulation in the liver; portal venography[J]. Radiology，.
- 10. Ito K， Shimizu A， Tsukuda T， et al. Evaluation of intraportal venous flow distribution by unenhanced MR angiography using three-dimensional fast spin-echo with a selective tagging pulse. efficacy of subtraction of tag-on and tag-off images acquired during a single breath-hold[J]. J Magn Reson Imaging， 2009， 29(5)：1224-1229.
- 11. Shirai Y， Wakai T， Ohtani T， et al. Colorectal carcinomametastases to the liver. Does primary tumor location affect its lobar distribution?[J]. Cancer， 1996， 77(11)：2213-2216.
- 12. Desai AG， Park CH， Schilling JF. “Streaming” in portal vein. Its effect on the spread of metastases to the liver[J]. Clin Nucl Med， 1985， 10(8)：556-559.
- 13. Konopke R， Distler M， Ludwig S， et al. Location of livermetastases reflects the site of the primary colorectal carcinoma[J]. Scand J Gastroenterol， 2008， 43(2)：192-195.
- 14. 任黎， 蔡成机， 詹绍康. 结直肠癌发生部位与肝转移分布的关系[J]. 外科理论与实践， 2006， 11(1)：46-47.
- 15. 吴阶平， 钟世镇， 裘法祖， 等. 腹部外科临床解剖学[M]. 济南：山东科学技术出版社， 2001：264.
- 16. 钟唐力， 张小明， 赵建农， 等. 肠系膜下静脉. 三维动态增强磁共振血管成像研究[J]. 中国医学影像技术， 2007， 23(4)：570-573.
- 17. 刘鹏， 鞠学红， 李春燕， 等. 16层螺旋CT检测肠系膜下静脉回流部位的临床意义[J]. 潍坊医学院学报， 2007， 29(2)：145-146， 197.
- 18. 李萍， 宋彬， 邬颖华， 等. 消化道腺癌肝转移病灶的多排螺旋CT表现[J]. 中国普外基础与临床杂志， 2005， 12(5)：518-520.
- 19. 汤敏， 孙俊波， 胡承雷. 肝转移瘤的CT诊断[J]. 西部医学， 2011， 23(1)：146-147.
- 20. ， 57(5)：685-690.
